Can Eczema Spread?

Eczema is a persistent disorder. Once it gains a foothold, it takes a lot of time, effort, trial and error to get rid of it. It’s mysterious, too, often appearing with no obvious warning that this itch-causing, rash-raising disorder was developing. 

There’s a strong association between rash and infectious disease–such as chickenpox or MRSA–so the uninformed sometimes assume that eczema rash indicates contagion. Some eczema patients are concerned that they might spread their eczema to other parts of the body. 

Can eczema be spread, either to other people or to other parts of the body? The answer is not as straightforward as a simple yes or no. 

No…

Eczema is a term applied loosely to a diverse collection of inflammatory skin disorders. It includes atopic dermatitis, dyshidrotic eczema, and seborrheic dermatitis. 

These different types of eczema are associated with different kinds of triggers and different kinds of lesions. They may affect different parts of the body. Seborrheic dermatitis, for example, mostly affects the scalp, back, nose, and forehead–places where more sebum, or oil, is produced. By contrast, atopic dermatitis tends to affect the cheeks, arms and legs. 

All types of eczema share two primary things in common: they are all associated with skin barrier dysfunction, and they all involve inflammation of the skin. 

 

The skin barrier

The skin barrier refers to interconnected skin cells (corneocytes), as well as the proteins (keratin, filaggrin, collagen), lipids, fatty acids, and amino acids that fill the spaces between them in the outermost layer of skin (the epidermis). The skin barrier creates a semi-permeable barrier that prevents irritants and germs from infiltrating the inner layers of skin. 

The skin barrier also prevents water molecules from permeating the skin cells beneath the corneocytes and damaging them. At the same time, it keeps water from evaporating from the skin cells and losing much-needed moisture (this is called transepidermal water loss, or TEWL). 

People with eczema often have genetic mutations that cause abnormal synthesis or breakdown of skin barrier proteins. While these mutations don’t guarantee that they will get eczema, they are more prone to eczema than others. If they are exposed to extremely dry conditions, air pollution, stress, or allergens, they can develop eczema. 

Inflammation

In addition to skin barrier dysfunction, people with eczema are also prone to inflammation. Inflammation is the result of an immune system response to irritants or pathogens. 

When foreign molecules irritate skin cells, it triggers the release of chemicals that act to break up, isolate, and flush out the irritant. Special cells infiltrate the invading material and then explode, blasting apart the cells of the external molecules. 

Blood vessels dilate to make it easier to transport nutrients to damaged cells and carry cellular debris away. Fluid is directed to the site of the injury or irritation, irrigating the tissues and allowing them to repair themselves while also diluting and flushing out foreign material. The lowermost level of the epidermis, the stratum basale, gets a signal to speed up production of skin cells to replace the damaged ones. Redness, swelling, itch, rash, and areas of thickened skin are all signs of this intensive process. 

When the immune system is functioning normally, this process starts only in response to actual threats to the body, and it shuts itself down once the offending molecules are extricated. 

It doesn’t work this way for people with eczema. Their immune systems pounce on “threats” that aren’t inherently harmful. The inflammation persists long after the foreign antigens have been neutralized.

Not Contagious

Eczema is not contagious. Because it’s a product of dysfunction in the body, not germs, it cannot be spread from one person to another. Fluids from eczema rashes will not spread the rash to other parts of the body. 

Eczema cannot be spread the way a viral or bacterial illness can. The rash does not spread over the body from contact between affected and unaffected skin. 

…But yes

Eczema cannot be spread person-to-person, nor can it be spread over the body by contact between eczema rash and unaffected skin. However, eczema can spread over the body if inflammation continues. Furthermore, while eczema is not contagious in itself, contagious pathogens can opportunistically infect eczema rashes, giving rise to pustules and other lesions that can transmit disease between people. 

How eczema spreads during a flare

If an eczema flare rages on, the skin barrier will continue to break down. Inflammation might begin in a new area with a persistent itch; as the person scratches, damage to the skin barrier triggers the formation of eczema lesions. 

Sometimes, people with eczema find that rashes erupt around small injuries to previously uninfected skin–this is called Koebner’s phenomenon.

Infected eczema

Infected eczema occurs when bacteria, viruses, or fungi opportunistically colonize skin affected by eczema rashes. 

Bacterial infection is by far the most common type of infection for eczema sufferers. Staphylococcus aureus (s. aureus), AKA staph, is the usual suspect. Streptococcus (strep) is another. 

Symptoms of bacterial infection include unusually itchy, red patches of skin, oozing yellowish pus, yellow, orange, or amber-colored crusts, red blisters with pain and warmth,  and red streaks. 

 

Bacterial infections only resolve with antibiotic treatments. If the infection doesn’t seem to respond to antibiotics, you could be infected with a strain of staph called methicillin-resistant Staphylococcus aureus (MRSA for short). This strain of staph does not respond to first-choice antibiotics; other antibiotics will be required to treat it. 

Eczema herpeticum is a viral skin infection caused by a herpes simplex virus (which causes fever blisters). The virus causes clusters of fluid-filled blisters that break and leave open sores. The virus can be spread through contact with the rash. It’s sometimes accompanied by fever and malaise. 

Eczema herpeticum is a serious disease and demands immediate treatment. It is treated with a topical antiretroviral drug called acyclovir. 

Fungal infections are caused by organisms such as candida yeasts. These organisms proliferate rapidly in areas such as the nails, underarms, and areas such as elbows where joints bend and flex. Fungal infection causes an intensely itchy, dark red, hive-like rash that looks remarkably similar to eczema lesions. Suspect it if your eczema rash does not respond to eczema treatments.

Depending on which fungus infects the skin, treatment could entail either topical or systemic antifungals. A corticosteroid cream like SmartLotionⓇ can be added to antifungal treatment to alleviate itching

Fungal infections may be spread via skin-to-skin contact or through contact with damp clothing, bed linens, or towels. 

An eczema cream such as SmartLotionⓇ works well for treating infective dermatitis symptoms; low doses of low-potency hydrocortisone won’t cause the skin to thin, and even after long-term use, it won’t cause topical steroid withdrawal. Used under a doctor’s guidance, it can be safely added to most prescription medication regimens. 

Preventing Infected Eczema

Moisturize regularly. Moisturized skin is less likely to crack or itch.

Don’t scratch. Scratching transfers pathogens from your hands to your skin. Wash your hands. Wash your hands without fail after using the restroom, going outdoors, visiting a hospital, or wiping noses. 

Sanitize surfaces used by multiple people. This pertains to school desks, door handles, sink faucets, wrestling mats, showers, and other areas shared by multiple people. 

Wash bed linens and towels frequently.

 Don’t swap linens, towels, or clothing with others without washing in between uses.

Avoid skin-to-skin contact with infected people. 

 

 

To summarize

On its own, eczema cannot be spread from one person to another, and it cannot be passed to one part of the body by contact with eczema sores on another part of the body. It can spread to different parts of the body if inflammation is not interrupted.

Eczema does make the skin more prone to opportunistic infections by bacteria, viruses, and fungi. When this happens, it is possible to transmit the pathogen to others through direct or indirect contact with the lesions. 

The skin barrier is more vulnerable to infection during eczema flares. Patients should keep their clothes, linens, and towels clean, and they should avoid sharing these items with others during active flares. 

With a doctor’s supervision, SmartLotionⓇ (eczema cream) can be used alongside treatments for bacterial and fungal infection (No creams should be applied to eczema herpeticum sores). SmartLotionⓇ is also a great candidate for treating ID symptoms that remain after prescription treatments. 

Skin infections can be serious, so see your doctor right away if you recognize signs of infected eczema. Ask your doctor about adding an over-the-counter treatment like SmartLotionⓇ for symptoms that don’t respond to prescription treatments. 

 

 

  Cee Van

  Medical Writer

  HarlanMD.com